THE SKY’S THE LIMIT

Eisenhower’s Residency Program Ready to Receive Residents

By: Roxanne Jones

The Leadership of the Graduate Medical Education Residency Program 300Eisenhower Medical Center’s residency programs in Internal Medicine and Family Medicine have received national accreditation, launching an important new chapter in the hospital’s development as a teaching hospital — and one that will have a significant, positive impact on the Coachella Valley community.

In July 2013, Eisenhower’s School of Graduate Medical Education and Research (GME) welcomed its first class of 16 medical school graduates who have chosen to specialize in Internal Medicine and Family Medicine and undertake their three-year residency training (eight residents in each of these two primary care specialties). In addition, Eisenhower filled six preliminary one-year residency positions in Internal Medicine in which the residents train in another specialty area. The process of submitting applications, conducting interviews and matching residents to the nation’s more than 1,000 teaching hospitals took an entire year.

The Applicat ion Process

“With our national accreditation, we are now listed on the American Medical Association’s (AMA) FREIDA Online® Web site,” says Nancy Arendt, Eisenhower’s Director of Graduate Medical Education Administration. The Web site is AMA’s database with more than 9,000 graduate medical education programs accredited by the Accreditation Council for Graduate Medical Education which medical students peruse to determine the residency programs for which they want to apply. “This site works hand in hand with ERAS, the electronic residency application service, which all medical students must go through to apply for residency programs,” continues Arendt. “Starting September 15, we began reviewing the applications sent to Eisenhower.” Arendt estimated that Eisenhower’s residency programs each received several hundred applications by the December 10 closing date. Between the two programs, nearly 30 applications arrived daily, and the number of on-site interviews were quickly filled to capacity.

“Starting October 4, 2012 and continuing through February 1 of 2013, we conducted interviews with interested candidates, generally seeing 10 to 15 students per program, per week,” she says. “Once the interviews were completed, we ranked everyone in order of our preference and sent that list to the National Resident Matching Program (NRMP), the organization that places applicants for postgraduate medical training positions into residency programs at teaching hospitals throughout the United States. The medical students also ranked the programs they’re interested in before a computer does its magic to match students and programs of interest.

“Around March 15, referred to as the ‘Ides of Match,’ the NRMP notified everyone about who was matched with whom,” notes Arendt. “At this point, we distributed contracts to those who matched with Eisenhower. These first-year residents — referred to as R-1s or PGY (postgraduate year) - 1s — came to Eisenhower during the last week of June for orientation and training in basic and advanced life support, then started their first rotations on July 1.” Arendt explains that residents do monthly rotations throughout their three-year training program, following a carefully planned curriculum.

Dr. Maureen Strohm (middle)
discusses patient assessment
with two medical students
during their clerkship rotation. 300A Total of 55 Residents by 2015 “When our first-year residents matriculate into their second year positions in 2014, we get a new set of R-1s and the process starts all over again,” she adds. As a result, by the start of the programs’ third year (2015) and thereafter, Eisenhower will have 24 residents in Family Medicine and 24 in Internal Medicine at all times. In addition, each year there will be six residents in what is called transitional year residencies (a one-year internship that provides preliminary education for applicants pursuing specialty residency programs that begin at more advanced PGY-2 levels, such as Anesthesiology, Radiology or Ophthalmology). There will also be a chief resident in Internal Medicine each year.

“By 2015, Eisenhower will have a total of 55 first-, second- and third-year residents undergoing training every year,” says Arendt.

“We started planning for these residency programs more than three years ago, and it came to fruition with the launch of applications this year,” says Joseph Scherger, MD, MPH, Vice President of Primary Care and Academic Affairs.

Why Being a Teaching Hospital is ImportantA teaching hospital is a facility that delivers medical care to patients while also providing clinical education and training to medical students, residents and postgraduate fellows. They also are often distinguished by their clinical research programs, through which medications, medical devices and new treatment methods are developed and tested. Teaching hospitals play an integral role in workforce training, research and patient care, especially for disadvantaged populations. Their commitment to excellence and innovation has earned the United States its reputation as a world leader in health care.

“Teaching hospitals are recognized for the high level of care they provide,” says Dr. Scherger. “Being a teaching hospital also enables us to attract top physicians who like to teach and contribute to the development of the next generation of physicians."

How Long It Takes to Become a DoctorAt least 11 years of education and training are required to produce a doctor: • 4 years for a bachelor’s degree • 4 years of medical school (Undergraduate Medical Education) • 3 to 7 years of residency training (Graduate Medical Education, or GME) • Optional fellowship (subspecialization) additional years (also referred to as GME)

Addressing the Shortage of Primary Care DoctorsContributing to the development of the next generation of physicians is more important than ever because the nation faces a growing shortage of physicians. According to the American Association of Medical Colleges (AAMC): • By 2015, the shortage will reach 62,900 physicians in all specialties: 91,500 doctors by 2020. • The Medicare population will grow by 36 percent over the next 10 years. • One-third of physicians will reach age 60 (and likely retire) in the next 10 years.

The Coachella Valley is facing a marked shortage of primary care physicians. That is why Eisenhower is focusing its initial residency programs on Internal Medicine and Family Medicine.

“There are parts of the Coachella Valley that have a ratio of one primary care physician to 9,000 residents, which ranks this as one of the areas of greatest shortage in the United States,” says Maureen Strohm, MD, Program Director of Eisenhower’s Family Medicine Residency Program. “We want to be part of the solution by training more primary care doctors.”

“It is estimated that at least 100 additional primary care physicians are needed to adequately serve the Valley,” adds Roy Young, MD, Program Director of Eisenhower’s Internal Medicine Residency Program, referring to the results of a Thomson Reuters survey that Eisenhower commissioned several years ago. “We’re hopeful that because our focus is almost exclusively on creating primary care internists, we will help to fill this gap over time.”

“Since that survey was conducted, we know the Valley’s population has grown and so has the need for additional primary care physicians,” notes Arendt. “Experience of other teaching hospitals tells us that 67 percent of residents will stay and practice in the area where they undertake their training, so we’re confident that we can grow our own primary care physicians who will stay and serve the populations here in the Valley.”

“We’re helping to produce good physicians and keep them here,” Dr. Scherger adds.

Helping to Care for the Medically UnderservedAnother important aspect of Eisenhower’s evolution into a teaching hospital is the way in which its residency programs expand the Medical Center’s ability to care for medically underserved populations here in the Valley, including the indigent and those with no health insurance.

“Our residents will not only practice at Eisenhower but also participate in the care of the less fortunate among the general population, spending time at ambulatory clinics in places like Indio and Borrego Springs,” explains Dr. Young. “It’s something we already do, but we will be able to extend our commitment in this regard.”

This outreach is typical of how teaching hospitals provide a health care safety net and serve their communities. The AAMC notes that, across the United States, teaching hospitals provide 41 percent of all hospital charity care.

Plus, teaching hospitals are more likely than nonteaching hospitals to deliver much-needed community health programs. For example, 89 percent of AAMCmember teaching hospitals offer AIDS services, compared to 16 percent of nonteaching hospitals. Teaching hospitals also support poison control centers, nutrition programs, substance abuse outpatient services, and crisis prevention programs. Notably, even before Eisenhower officially became a teaching hospital, it has been committed to providing these types of outreach programs to serve the Valley.

What’s on the HorizonWhile the official launch of Eisenhower’s residency programs was an exciting milestone and fulfillment of a key phase of becoming a teaching hospital, there are other important plans for the future for Eisenhower’s School of Graduate Medical Education and Research.

A fellowship program in both Geriatrics and Sports Medicine will likely start in 2016. In reference to post-residency subspecialty training, and given the size and nature of Eisenhower Medical Center, we’re likely to offer graduate medical education in other areas of excellence.

Update: Eisenhower’s Medical Student ClerkshipThe first phase of Eisenhower Medical Center’s evolution into a teaching hospital began with Family Medicine clerkships in July 2010. Since that time, the program has expanded significantly.

Clerkships are periods of instruction, or rotations — generally during the last two years of medical school — that take place in a hospital or hospital clinic setting. Clerkships may range in length from four to 12 weeks, during which time students work with patients and their families in inpatient and outpatient settings. They are supervised by physician faculty members, or the attending physicians, and work with other members of the health care team.

“We now offer clerkships in Family Medicine and Internal Medicine as well as Cardiology, Emergency Medicine and Geriatrics,” says Joseph Scherger, MD, MPH, Vice President of Primary Care and Academic Affairs. “We also have one that focuses on HIV/AIDS, and another on hospital medicine.

“We have as many as 12 students here at one time, and about 100 students total have rotated through Eisenhower since the program started,” he continues. “We’re introducing students to a variety of areas in the health care system, both in clinics and the hospital, and at least ten have said they’ll apply for our residency programs in Internal Medicine or Family Medicine. “The medical student clerkship program also gives our faculty teaching experience, and it gets our name and reputation out among medical schools which attracts other students who may wish to come here,” he adds.

As a result, the number of medical schools from which students are coming to Eisenhower for clerkships is also growing.

“We have master affiliation agreements with the Keck School of Medicine of the University of Southern California and Loma Linda University School of Medicine,” explains Nancy Arendt, Director, Graduate Medical Education Administration. “We also have affiliation agreements with California Hospital Medical Center (Los Angeles); Temple University (Philadelphia); Touro University Nevada (Henderson, Nevada); Western University of Health Sciences College of Osteopathic Medicine of the Pacific (Pomona, California); Samford University (Birmingham, AL) and we have a memo of understanding with the Bush Naval Hospital at 29 Palms.”

Essentially, Arendt notes, an affiliation agreement is triggered as soon as a student indicates he or she wants to come to Eisenhower for a clerkship. As the word of Eisenhower’s programs spreads, the Medical Center is likely to see more students from more medical schools around the United States.